What is the likelihood of recurrence of lichen sclerosis after treatment with topical steroids?

From the Guidelines

The likelihood of recurrence of lichen sclerosus after treatment with topical steroids is approximately 40%, as about 60% of patients experience complete remission of their symptoms. Even with successful initial treatment using potent topical corticosteroids like clobetasol propionate 0.05%, many patients will experience a return of symptoms when treatment is discontinued or reduced 1. Typical treatment involves an intensive phase of applying a potent topical steroid once or twice daily for 1-3 months until symptoms improve, followed by a maintenance regimen of 1-3 applications weekly to prevent recurrence. Long-term maintenance therapy is often necessary, as complete cure is rare. Factors that may influence recurrence include treatment adherence, the potency of the steroid used, duration of treatment, and individual disease severity. The high recurrence rate is related to the chronic autoimmune nature of lichen sclerosus, where the underlying inflammatory process persists even when symptoms are controlled. Regular follow-up examinations are important to monitor for recurrence, complications, and the rare risk of malignant transformation.

Some key points to consider in the management of lichen sclerosus include:

• The use of clobetasol propionate 0.05% ointment as the first-line treatment, applied once daily for 1-3 months, with a gradual reduction in frequency as symptoms improve 1
• The importance of patient education on the safe use of ultrapotent topical steroids, including the amount to be used, site of application, and potential side effects 1
• The need for long-term follow-up to monitor for recurrence and complications, particularly in patients with ongoing active disease 1
• The consideration of referral to a specialist clinic for patients with persistent or recurrent disease, or those who require surgical management 1

Overall, the management of lichen sclerosus requires a comprehensive approach, including topical steroid treatment, patient education, and regular follow-up to prevent recurrence and complications. The most recent and highest quality study recommends the use of clobetasol propionate 0.05% ointment as the first-line treatment, with a treatment regimen of once daily for 1-3 months, followed by a maintenance regimen to prevent recurrence 1.

From the Research

Likelihood of Return of Lichen Sclerosis after Treatment with Topical Steroids

• The likelihood of recurrence of lichen sclerosis after treatment with topical steroids is a significant concern, as the condition is chronic and relapsing in nature 2, 3.
• Studies have shown that continuous treatment with topical corticosteroids is often required to manage the condition, and recurrence after stopping treatment is frequent 2.
• However, proactive maintenance therapy with a topical corticosteroid, such as mometasone furoate 0.1% ointment, has been shown to be effective in keeping lichen sclerosis in remission and reducing the risk of relapse 3.
• In one study, none of the patients in the mometasone furoate 0.1% ointment group experienced a relapse, compared to 56% and 62% of patients in the vitamin E and cold cream groups, respectively 3.
• Another study reported a case of penile lichen sclerosus treated with topical corticosteroids for over 25 years without significant side effects, suggesting that long-term use of topical corticosteroids may be effective in managing the condition 4.
• Alternative treatments, such as topical tacrolimus, have also been shown to be effective in treating lichen sclerosis, particularly in patients who are unresponsive or poorly responsive to topical corticosteroids 5, 6.

Factors Influencing Recurrence

• The chronic and relapsing nature of lichen sclerosis makes it challenging to manage, and recurrence is a common problem 2, 3.
• The effectiveness of topical corticosteroids in preventing recurrence is influenced by factors such as the potency of the steroid, the duration of treatment, and the frequency of application 3, 4.
• Proactive maintenance therapy with a topical corticosteroid may be an effective strategy for preventing recurrence and managing the condition long-term 3.